Medicare & Home Health Care: What You Need to Know

Many Medicare beneficiaries prefer to receive care in the comfort of their homes instead of in a hospital or nursing facility. Medicare covers certain home health care services, but there are eligibility requirements and limitations to be aware of. This guide will help you understand what’s covered, how to qualify, and how to maximize your benefits.

What Home Health Services Does Medicare Cover?

Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) cover a range of home health services if you meet specific criteria. Covered services include:

1. Skilled Nursing Care

• Part-time or intermittent nursing care provided by a registered nurse (RN) or licensed practical nurse (LPN)

• Includes wound care, injections, monitoring vital signs, and medical assessments

2. Home Health Aide Services

• Help with personal care, such as bathing, dressing, and hygiene

• Medicare does not cover 24/7 home care or custodial care (long-term assistance with daily living activities)

3. Physical, Occupational, and Speech Therapy

• Physical therapy: Helps regain strength and mobility after illness or injury

• Occupational therapy: Assists with daily activities like dressing, eating, and using assistive devices

• Speech therapy: Improves communication and swallowing issues

4. Medical Social Services

• Counseling and social work services to help manage emotional, financial, and social challenges related to a health condition

5. Medical Supplies and Equipment

• Certain durable medical equipment (DME), such as wheelchairs, walkers, and oxygen equipment, may be covered under Medicare Part B

  
  

Who Qualifies for Medicare-Covered Home Health Care?

To be eligible for home health care under Medicare, you must meet the following requirements:

✅ You must be under the care of a doctor who certifies that you need home health care. ✅ Your doctor must create and regularly review a care plan. ✅ You must be homebound, meaning you have difficulty leaving home without assistance. ✅ You need skilled care (nursing or therapy) on a part-time or intermittent basis. ✅ The home health agency providing care must be Medicare-certified.

What’s Not Covered by Medicare?

While Medicare covers many essential home health services, it does not cover:

• 24-hour home care

• Homemaker services (cleaning, cooking, or shopping)

• Long-term custodial care

• Personal care services if no skilled care is required

If you need these services, you may need to explore Medicaid, long-term care insurance, or private pay options.

How to Get Medicare Home Health Care

If you think you or a loved one qualifies for home health care, follow these steps:

1️⃣ Talk to Your Doctor – Request an evaluation and a home health care plan. 2️⃣ Choose a Medicare-Certified Home Health Agency – Use Medicare’s Home Health Compare tool to find approved providers. 3️⃣ Verify Costs – While Medicare covers most services at 100%, durable medical equipment (DME) may require 20% coinsurance under Part B.

Medicare Advantage and Home Health Care

If you have a Medicare Advantage (Part C) plan, your benefits may include additional home health services. Coverage varies by plan, so check with your provider to confirm what’s covered and which agencies are in-network.

Final Thoughts

Medicare home health care benefits allow you to receive quality medical care while remaining at home. Understanding eligibility and coverage details can help you take full advantage of these services.

Need help navigating Medicare’s home health care benefits?

Lindbergh and Associates is here to assist! Contact us today for expert guidance on finding the right Medicare plan for your needs.

📞 Call us today or schedule a consultation online!